Increasing cynicism is No. 1 predictor of nursing home administrator turnover, research shows

Nursing home administrators do not believe that pay-for-performance improves care quality or facilit

Nursing home administrators with high levels of cynicism related to a feeling of professional burnout are most likely to leave their job, suggests new research from Indiana University of Pennsylvania.

The findings, posted online last week, are the doctoral thesis of former nursing home administrator Christina Daley, Ph.D., NHA.

To distribute a survey to all Pennsylvania nursing home administrators, Daley enlisted the help of long-term care organizations such as LeadingAgePA, the Pennsylvania Health Care Association, and the Pennsylvania Association of County Affiliated Homes. She received 98 responses. She analyzed these responses to determine the administrators' turnover intention and level of burnout, using a theoretical framework that defined burnout as having three elements: emotional exhaustion, cynicism and professional inefficacy.

“Both emotional exhaustion and cynicism are strong predictors of intentions to turnover in current position and in the NHA profession,” Daley wrote. “However, cynicism is the strongest predictor of the two turnover intentions.”

While cynicism emerged as a stronger predictor in this analysis, the importance of emotional exhaustion should not be overlooked, Daley emphasized in an email to McKnight's. Studies outside the realm of nursing homes that have used this framework have indicated that emotional exhaustion is the “core dimension” of burnout, she noted.

Cynicism in this context is characterized as a state of disengagement or depersonalization, in which a professional comes to see a client as an “impersonal object” without “unique characteristics,” according to Daley. Work stress, excessive interpersonal interactions and excessive workloads all have been linked by researchers to higher levels of cynicism, she noted.

Emotional exhaustion — or a feeling of being overwhelmed — can have similar causes, and also can lead to emotional distancing, Daley wrote.

The three dimensions of burnout are linked, in the framework Daley used, to a number of “worklife areas,” such as workload overload, control over work conditions and sense of community. Among the administrators in this study, “remarkably few” of these worklife areas strongly affected administrators' sense of burnout, Daley found.

Perhaps unsurprisingly, she found that workload manageability was strongly linked to emotional exhaustion, while administrators with a strong sense of community were less likely to be cynical. Nursing home companies have an important role to play in fostering this sense of community and aligning administrators' values with bottom-line imperatives, Daley told McKnight's.

“The findings suggest the importance of organization executives in supporting NHAs in their mission of caring, as too much focus on the bottom line is alienating,” she wrote. “NHAs need to create a community of support for themselves with other NHAs, and within their organizations among their staff. It is the sense of community and associated support that enable NHAs to manage the complexities associated with providing care in the LTC environment.”

Organizational development programs that focus on team building skills, individual self-assessments of burnout, and including burnout coping skills in administrator licensure requirements are among the potential interventions Daley proposed in her 249-page thesis.

Whatever steps are taken, she emphasized that the NHAs in her study demonstrated “significant levels of emotional exhaustion and cynicism,” showing the need for action to maintain consistent, skilled leadership in this sector.

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